Booster vaccination of adults with reduced-antigen-content diphtheria, Tetanus and pertussis vaccine: Immunogenicity 5 years post-vaccination
Introduction
Routine vaccination against pertussis has been recommended for infants since the 1940s, yet it is only within the last decade, corresponding to availability of acellular pertussis vaccines and reduced-antigen-content formulations, that recommendations for booster vaccination of adolescents and adults against pertussis have been developed. Although pertussis disease rarely results in serious complications, hospitalisation or death in older individuals [1], [2], it nevertheless carries a substantial disease burden and economic cost in this population [1], [2], [3], [4]. Recommendations for pertussis booster vaccination of adolescents and adults have been made with the aim of reducing morbidity and healthcare costs in the older population and reducing pertussis transmission to unprotected or partially protected infants by these older individuals. National authorities in Australia [5], United States [6], Canada [7], France [8], Germany [9], Austria, Finland, Andorra and Luxembourg [10] now provide guidelines for pertussis vaccination in older age groups, and several of these countries provide public, fully funded vaccination programs for adolescents. In Australia, an adolescent pertussis booster program was funded for 15–17 year olds in 2003 [5]. Unfunded recommendations for a single dose of dTpa (combined reduced-antigen-content diphtheria–tetanus-acellular pertussis vaccine) for adults were also made in 2003 for parents of a new baby, adults working with young children, especially in a healthcare setting, and other adults where Td vaccine (adult diphtheria–tetanus vaccine) is indicated (at 50 years of age, and more recently, for primary immunisation of adults) [11]. Expert consensus groups continue to advocate strategies to improve vaccination for adolescents and adults primarily directed at protecting susceptible infants against pertussis disease [12], [13]. However, since the duration of protection afforded by acellular pertussis booster vaccines against pertussis disease remains largely unknown, recommendations for subsequent booster doses are lacking.
This study is part of an ongoing assessment into the long-term persistence of antibodies among adults who participated in a trial comparing a single booster dose of dTpa vaccine with stand-alone pa and Td vaccine [14] at 48 and 60 months following vaccination. These data are important because they provide one of the longest periods of follow-up for adults receiving dTpa worldwide and inform policy development for the control of pertussis in adults.
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Subjects
This was an open serological follow-up study (263855/026 and 027) conducted at the Centre for Immunisation Research, The Children's Hospital at Westmead, New South Wales, Australia. The results of the preceding vaccination study and serological follow-up studies at 12, 24 and 36 months after vaccination have been reported previously [14], [15]. Briefly, adults aged 18 years or above were randomised to receive either a single injection of a combined dTpa vaccine or Td vaccine followed by
Study population
Of the 550 subjects enrolled in the initial randomised trial [14], 361 (66%) and 308 (56%) subjects returned at the Month 48 and Month 60 sampling time points, respectively (Table 1). Four subjects (all dTpa recipients) were excluded from the primary analysis of the Month 60 cohort due to large (at least ninefold) increases in anti-tetanus or diphtheria antibody concentrations between Month 48 and Month 60. Increases in antibody concentration of this magnitude were considered indicative of
Discussion
This study of yearly serological follow-up of an adult cohort vaccinated with the combined dTpa compared with commercially available Td (+experimental pa vaccine) shows that, in line with previous predictions based on mathematical modelling [16], the long-term persistence of seroprotective diphtheria and tetanus antibodies is similar, despite the significantly higher anti-tetanus antibody GMCs initially observed in the Td-vaccinated group 1 month after the booster dose [14], [15]. Since
Acknowledgements
The authors thank Dr. Joanne Wolter and Julia Donnelly for assistance in preparation of the manuscript and Gunasekaran Ramakrishnan for additional statistical analyses.
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An observational study of antibody responses to a primary or subsequent pertussis booster vaccination in Australian healthcare workers
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Measuring Immune Response to Commonly Used Vaccinations in Adult Recipients of Allogeneic Hematopoietic Cell Transplantation
2017, Biology of Blood and Marrow TransplantationCitation Excerpt :Anti-TT and anti-DT titers ≥ .1 IU/mL have been shown to be protective against tetanus and diphtheria and are widely used as cut-offs to determine response to vaccination [55]. Although there is no widely accepted cut-off to define positive anti-PT titers, many studies have used values ≥ 5 IU/mL to define a positive anti-PT titer [56-60]. Current guidelines recommend administration of 3 doses of tetanus/diphtheria-containing vaccine beginning 6 months after HCT [53,57,59,60].
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2017, The Lancet Infectious DiseasesExperience with monocomponent acellular pertussis combination vaccines for infants, children, adolescents and adults-A review of safety, immunogenicity, efficacy and effectiveness studies and 15 years of field experience
2013, VaccineCitation Excerpt :IgG anti-PT levels achieved after vaccination with TdaP predict antibody persistence [67], and it was recently suggested that the increased pertussis toxin production of the new circulating P3 strains of B. pertussis would be less likely to cause pertussis in the presence of higher levels of circulating neutralising anti-PT in the populations [8]. Anti-PT levels have been shown to decline rapidly during the first years after TdaP booster vaccination of adults [65,67]. Interestingly, a recent small investigation in Danish adults indicated that anti-PT levels declined more rapidly in patients who had experienced pertussis than in healthy adults booster vaccinated with the Danish aP vaccine [75].